Speaking truth to power in China

23rd March 2007

Today I was in the presence of greatness â€” greatness in this case being a tiny Chinese octogenarian named Gao Yaojie.

Dr. Gao, a firebrand obstetrician and one of Chinaâ€™s first female physicians, this week paid a maiden visit to the United States to receive a humanitarian award for what began as a quixotic one-woman fight against AIDS in the worldâ€™s largest country.

Dr. Gao was born so long ago that her feet were bound into tiny bundles no larger than my mobile phone, as was the custom among the aristocracy in Old China. She survived Japanese air raids and only just lived to tell about her beating at the hands of Chairman Mao Zedongâ€™s Red Guards when she refused to join them in service to fanatical socialism during the 1960s and 70s. She walks slowly and painfully, but I donâ€™t know if itâ€™s her bound feet, her long-ago beatings, or her advanced age thatâ€™s to blame. Or maybe it's the burden she carries with her always as a doctor and an advocate for some of China's sickest and poorest patients.

Back in the 1990s, when Chinese dogma held that AIDS was a foreignersâ€™ disease, Dr. Gao learned that HIV was decimating central Henan province. A government-endorsed blood-selling campaign had led to the infection of thousands of farmers. She traveled to villages to provide medical care and free informational brochures to people who had no idea why they were dying â€” and took on the local cadres who were trying to cover up the mounting crisis. She was harassed and hounded, but she persisted.

On Feb. 1, as she headed out to collect a U.S. visa so she could attend a banquet to be held in her honor in March by Vital Voices Global Partnership in Washington, she was detained. Only under international pressure was she allowed to visit and collect her award at all.

Today she came to Radio Free Asia, where she was interviewed by my colleagues Zhang Min and Shen Hua in Mandarin Chinese about her work, her life, and the struggle to eradicate AIDS in the worldâ€™s largest country. Her small stature and slow gait belie a unique intensity and fierce temperament that surely lie behind the dismissive, almost-Gaullic â€śfffftâ€? sound and hand-wave she makes at the mention of top Chinese officials, whom she clearly cannot abide.

â€śI am very concerned that the authorities will find new ways to keep me down when I return to China,â€? she said in her heavy Henan accent, her interview translated into English by another RFA colleague, Luisetta Mudie.

â€śI am particularly worried about my family. Both my sonâ€™s and my e-mailboxes have been closedâ€¦â€?

In the early 1990s, commercial blood stations flourished in Henan. Some farmers who sold blood became infected with HIV through unclean equipment. Sellers sold blood by volume, so to reduce payments and allow farmers to recover faster, the stations often re-transfused them with red blood cells left after the valuable plasma was taken. Now, Gao says the problem hasnâ€™t been solved, just brushed under the rug.

â€śThe government-run blood-banks are closed. But not only have the black market blood-banks not closed, they are on the increase again,â€? she said. â€śRecently they discovered some people in Guangzhou who had been selling their blood for 10 years, from midnight to 6 a.m.â€?

Gao is credited with saving hundreds of thousands of lives in China after she launched a one-woman crusade to expose the blood plasma donor business that triggered an HIV/AIDS epidemic in Henan province. It was she who found a link among a rising number of patients with AIDS: All had donated blood plasma at unsanitary collection centers, for about U.S. $5 per donation.

She said AIDS often left the poorest and most vulnerable in society without hope or help. â€śI have seen a young child of 19 months die of AIDS and an old man in his 70s in a Henan hospital. The situation for women is even worse, because they can often be hit by AIDS via blood transfusions during childbirth, or they sell blood...And itâ€™s not just in Henan. There are many other places where the problems are just as bad. In Shanxi itâ€™s even worse than in Henan.â€?

Different in China

â€śThe epidemic is different in China from anywhere else because I have spoken to AIDS groups here in the United States and they say it is mostly transmitted through sex and intravenous drug use. But in China, while I donâ€™t deny the transmission of the virus through sex between men, and I donâ€™t deny drug use, the largest part of transmissions occur through the blood trade,â€? Gao said. â€śMost of the cases I have seen werenâ€™t transmitted sexually. They were transmitted through blood transfusions.â€?

Gaoâ€™s view isnâ€™t popular in many circles, where local officials tend to report HIV infections as transmitted by intravenous drug use, making the illegal blood-trade less visible on the official record. She has been repeatedly harassed, had her phone cut off, and held under virtual house arrest by local officials angered by her forthright style and tireless work on behalf of Chinaâ€™s AIDS patients and orphans.

Many cases, many causes

In December, UNAIDS reported in its 2006 Epidemic Update that the Asia-Pacific region suffered 630,000 deaths from AIDS-related illnesses in 2006. HIV infection risk is associated in Southeast Asian countries with unprotected commercial sex, sex between men, and unsafe injecting drug use, the Update said. The report blames the failure of governments to adequately address the role of sex between men in the epidemic.

A Feb. 24 article in The Lancet notes that Chinaâ€™s first AIDS case was identified in 1985 in a dying tourist. By 1998, HIV had reached all 31 provinces and a phase of exponential growth, with 650,000 infections by 2005. Gao lauded the health ministry in Beijing for taking an enlightened view of HIV/AIDS in China. But she wasnâ€™t very optimistic that the vision of leaders in Beijing would ever be implemented on the ground. â€śThe level of education of local officials is really very low,â€? she said.

I asked Dr. Gao how her gender may have slowed, or accelerated, her career and her cause. A good clinician, she answered the question obliquelyâ€”directing my attention away from herself and toward the massive problem at hand. â€śThis work is very, very hard. Very difficult,â€? she said. â€śMost people, male as well as female, simply burn out after short periods of working with AIDS patients in China.â€?

Then she handed me a CD filled with photos she has taken of Chinese AIDS patients. â€śI can tell you a story about every one of them,â€? she said. â€śEvery one.â€?